An anterior capsulotomy procedure is one wherein the surface of the anterior capsule of an eye is broken or partially removed allowing access to the anterior thereof. Procedures commonly performed as part of a cataract removal and other ophthalmic procedure.
The most typical anterior capsulotomy procedure performed is a "can opener technique" in which the bent tip of a 23 or 25 gauge needle inserted between the anterior capsule surface and overlying cornea is used to rip a series of small connected tears in the anterior capsule. This procedure produces flaps of anterior capsule material, called tags, which remain to obscure the surgeon's view of the capsule and to interfere with the removal of the lens and/or cortical material and the placement of an artificial lens. The tears produced by this method can also allow an implanted artificial lens to slip or escape entirely from the capsule.
At the November, 1984, Academy of Ophthalmology meeting, it was suggested that a unipolar electric probe could be used for capsule "cutting". When the probe electrode contacts the anterior capsule it permits an electric current to be passed between it and a receiving electrode contacting a patient's body elsewhere. The current coagulates the anterior capsule making it extremely friable. It was suggested that a chisel-shaped electrode could be used for simultaneously coagulating and "cutting" the coagulated capsule.
Among the significant advantages of the system was the minimization if not elimination of tags and tears. However, the proposed procedure has significant disadvantages including the possibility of producing capsule shrinkage and the rupturing of adjacent zonules from excessive heat produced by the unipolar probe. Other disadvantages include the not insignificant cost of the equipment.
There are commercially available cystitomes for such procedures providing a cutting edge with fixed orientation at the end of a handle. However, these devices also require an extremely large limbal incision or a number of smaller incisions to remove a central portion from the capsule.